Schizophrenia Treatment: What Are The Options?

Reviewed by Aaron Horn, LMFT

Published 12/22/2020

Schizophrenia is a severe mental illness that impairs people’s perceptions, actions, and thoughts. It disrupts their ability to perform at work and interact with other people. It alters the person’s idea of reality and belongs to a group of disorders called psychosis.

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Fortunately, schizophrenia is now more responsive to treatment than before. Some people may experience significant recovery, while others might have occasional episodes of schizophrenia. Many treatments are available to help people manage the symptoms and thrive. When the patient adheres to the treatment plan, they can live satisfying and successful lives.

The Need For Prompt Treatment

Studies have shown that early intervention is generally more effective before the condition has caused significant damage. Schizophrenia is a chronic disorder that lies on a wide spectrum and demands life-long treatment. Some people erroneously believe that schizophrenia is a death sentence and have associated the disorder with many things, from homelessness and poverty to unemployment.

However, this does not have to be the case. Although schizophrenia can be devastating, effective treatment can help patients control the symptoms and the psychosis associated with schizophrenia. However, medications are not effective for getting a job, improving coping methods, and interacting with others. This is the place of psychosocial and support therapies. They are crucial for alleviating the symptoms and living healthily.

It is crucial to seek medical attention for someone with schizophrenia. Other conditions such as diabetes, cardiovascular disease, and lung diseases are common in patients, and the affected patient rarely gets proper medical care for such ailments.

Schizophrenia Treatment Options

Schizophrenia treatment entails the combination of psychological, medical, and psychosocial interventions. Most of the care is provided on an outpatient basis. A psychiatrist can provide treatment, but a team of other mental health professionals, including nurses, doctors, social workers, clinical psychologists, and occupational therapists, can play a part. These mental health professionals will customize the treatment to fit the needs of the patient.

Medications For Schizophrenia

Medication is the primary focus of schizophrenia treatment. However, one of the major issues with medication is that many patients quit using it. In some cases, it might be because the medication seems ineffective or the side effects are unbearable. The choice of medication must be a collaborative effort between the patient and the doctor. When applicable, it might help to consider the opinions of the caregiver. The decision should always cover a proper discussion of the possible side effects.

It is also important that people with schizophrenia discuss with their doctor before quitting or changing their medication. Be sure to mention any concerns or reservations. It is possible to control most of the side effects, and there is a great risk of symptoms reoccurring after quitting medications. You can work with a doctor to determine the most effective option.

Two categories of medications can be effective for schizophrenia treatment. Traditional antipsychotics have been in use since the mid-1950s. These meds block dopamine receptors and control delusions, hallucinations, and confusion associated with schizophrenia effectively. Examples include haloperidol, chlorpromazine, and fluphenazine.

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Mild side effects of traditional antipsychotics include blurred vision, constipation, dry mouth, and dizziness. These side effects usually go away a few weeks following the commencement of treatment. More severe side effects include difficulty with muscle control, cramps, spasmsin the head or neck, tremors, fidgeting. Another common side effect is feet shuffling, which is also common with patients with Parkinson’s disease.

Some side effects may occur due to prolonged use of regular antipsychotics, including tongue thrusting and rolling, facial tics, panting, grimacing, and lip licking.

Atypical antipsychotics, including quetiapine, olanzapine, and risperidone, were provided in the 90s. These drugs are thought to act on the serotonin and dopamine receptors, and therefore might effectively treat the positive and negative symptoms of schizophrenia. Atypical antipsychotics have side effects different from regular antipsychotics, including type II diabetes, weight gain, sedation, sexual dysfunction, and irregular heartbeat.

Before now, medical practitioners started patients with a high dose of the medication and lowered it at the condition's maintenance stage after successfully treating an acute episode. However, today, the suggested approach is to begin treatment with a lower dose.

Psychotherapy

Psychotherapy has a major role to play in schizophrenia treatment. For example, research published in 2015 showed that patients who suffered their first episode of psychosis, usually in their 20s, had the best prognosis by applying a team-based approach. The team-based treatment approach included psychotherapy, low doses of antipsychotic medicines, family education and support, work or education support, and case management.

With a proper medication plan, psychotherapy can help a person stay consistent with treatment, learn basic social skills, and complete their weekly goals and activities. It can also be beneficial for undertaking daily activities, such as cooking, personal care, and communication with loved ones and co-workers. Therapy or rehabilitation therapy can help restore confidence in people to take care of themselves and live purposefully.

Group therapy, in combination with medications, shows significantly better outcomes than drug intervention only. It is more likely to get positive results when the group therapy targets real-life plans, issues, and relationships; adherence to drug therapy and talks about the side effects; social and work obligations and interactions; or some hands-on work or recreational activity. Supportive group therapy can be beneficial for reducing social isolation and improving human interaction.

Family therapy can also lower the relapse rates. People with schizophrenia who get proper aftercare have a 50 to 60 percent chance of relapsing in their first year away from the hospital. Supportive family therapy can lower the relapse rate to less than 10 percent. Family therapy motivates loved ones to gather for a meeting whenever there is an issue to discuss and determine the precise nature of the issue, highlight and evaluate alternative solutions, and cooperate on the best solution.

Other treatments are getting the backing of research for schizophrenia treatment. For example, cognitive-behavioral therapy (CBT) targets distressing, strongly-held opinions by checking the evidence to support them, finding and accomplishing life objectives, adopting coping skills, and improving life quality.

Acceptance and commitment therapy (ACT), which focuses on mindfulness, does not exactly try to decrease psychotic symptoms. Instead, ACT tries to reduce the person’s distress by improving their tolerance level to the symptoms. The patient learns how to identify psychotic symptoms, like hearing voices, by being curious, welcoming, open, and non-judgmental, rather than being overwhelmed by the adverse reactions. They also discover their purpose and values and receive empowerment to build meaningful and satisfying lives.

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Assertive Community treatment is another type of evidence-based intervention for schizophrenia, also shortened as the ACT, but is different from Acceptance and Commitment Therapy. ACT takes a multidisciplinary team approach, usually including social workers, psychiatrists, case managers, and other mental health professionals. It is an enhanced method of intensive case management, where team members work on a caseload, attend to the client at least once weekly, and provide outreach to people in the community.

ACT is usually ongoing and highly customized to fit the patient’s changing needs. ACT aims to lower hospitalization rates and help clients adjust to community life. ACT is for people who are at high risk of being hospitalized and struggle to remain committed to conventional mental health treatments.

Cognitive remediation (CR) is a temporary intervention for improving cognitive skills necessary for regular social or vocational functions in people with schizophrenia (like computer use or paper and pencil tasks). Most CR interventions also consider the lack of motivation and emotions that is common with schizophrenia. There is evidence to show that temporary cognitive training therapies can change neural connections, as revealed in some studies in neuropsychological testing. However, it is uncertain if the improvements to brain functions are long-lasting or simply mean better functionality.

Likewise, cognitive adaptation treatment (CAT) focuses on the cognitive barriers of schizophrenia. These disrupt normal functions and cause symptoms such as impulsivity, apathy, and challenges with the mental effort necessary for problem-solving. CAT entails multiple visits to the person’s home. During the visit, the therapist will develop ways to help the patient cope and manage their challenges. For instance, the therapist may rearrange items around you, create checklists and reminders, and assist you with a routine.

Social Skills Training

Because schizophrenic patients experience delusions and hallucinations, they might struggle with what is real and what is not. The same uncertainty can occur with interpersonal relationships, causing unhealthy dynamics between the patient and other people. Learning the basics of relationships can help patients better handle family lives, social circles, and perhaps even their work environment.

Deep Brain Stimulation

When the available treatment options do not appear to be effective for controlling symptoms, the doctor may recommend a deep brain stimulation treatment. It is regarded as an invasive procedure since surgery is required to place the neurostimulator. It is then possible to send electric impulses to certain brain areas through the device and control symptoms without damage.

Complementary And Alternative Medicine

Animal Assisted Therapy (AAT): Like other conditions, animal-assisted therapy can help improve and manage schizophrenia symptoms. Anhedonia, which means the inability to experience joy or pleasure, is a common sign of schizophrenia. Research has shown that in clinical trials involving animal-assisted therapy for treatment, patients noticed a higher level of pleasurable feeling than those who were not part of the AAT group.

Finding Treatment

If you have noticed schizophrenia symptoms, it is advisable to talk to your doctor. They may perform blood work or run tests to rule out other medical conditions that may cause the symptoms. Afterward, patients will meet with a licensed mental health professional to discuss the symptoms.

Note that you may need to undergo extensive evaluation for an accurate diagnosis. The evaluation process requires a meeting to discuss your experiences and a spouse or other relatives' involvement to get more information. Treatment may be outpatient, intensive outpatient, or a residential treatment approach. The mental health professional conducting the evaluation will decide the appropriate level of care for your situation. There are trained experts who specialize in schizophrenia treatment at every level of care.

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People with schizophrenia do not always need long-term hospital treatment. The medical team may visit the patient at home and provide support during an episode. Those in recovery or remission can undergo treatment at regular appointments by visiting the clinic. There are times when a short stay at the hospital may be required, like:

  • If you pose a risk to yourself or others
  • If you need time away from stressors or things that trigger the symptoms
  • When it is time to change medications
  • If you feel distressed by the symptoms
  • If the treatment required is only available in the hospital.

You may fear visiting the hospital. Note that all the healthcare personnel is obligated to treat you with respect and explain things in clear terms. You can request to have a close relative or friend accompany you during admission. During the hospital stay, friends and family can visit and spend time with you.

In Conclusion

You should be calm and take it easy on yourself and the medical team during the treatment process. As much as recovery is important, everyone has a different idea of what treatment approach works more effectively. Part of the treatment plan is to check and identify effective methods for managing and treating schizophrenia symptoms.

Staying compliant with the treatment plan is essential for success. This means using medications as instructed, going for appointments regularly, participating actively in counseling and group therapy, asking the support group for help, and informing the doctor of any symptoms or changes. Remind yourself that the path to recovery is a process, and even if it feels challenging, you can take steps to make the journey easier. You can get started by taking an online schizophrenia assessment test today.